Academia to the workplace; how to navigate the minefield!

The industry can be a minefield for new dentistry graduates or those at the early stages of their career. As competition for jobs and opportunities increases, so do the demands placed on those entering our profession.

Today we have the opportunity to talk with young GDP Natalie Bradley, about her transition from academia into the workplace. Natalie discusses the steep learning curve a dentist must navigate when applying their theoretical, cosmetic-based training into an economic reality. As well as offering crucial information for new dentists,  Natalie’s thoughts also offer a valuable insight for senior dentists looking to hire. Those dentists who appreciate the pressures of professional life for today’s graduates, are best placed to offer appropriate support networks and make the most of their associate team.

Aalok Y Shukla:          Hi, Natalie. Today I’d like to discuss the dental industry from a young dentist’s perspective. It would be good if we can  get your insights on how you think things are, where you see things going, and just kind of, go from there.

Natalie Bradley:           Okay, great.

Aalok:                           Perfect.  Any opening thoughts Natalie?

Natalie:                Obviously, I’ve thought about this quite a lot in the past year and since coming out of dental school. Things have been a lot more challenging in terms of what I expected when I first applied to dentistry. It was very much, you study for five years, you come out and you get a job. Everything’s very comfortable. It’s easy to get a job as a dentist and you get a lot of money. You’d work nine to five, and that’s kind of it!

 What I’ve come to realise is that it’s not like that. Things are getting much more difficult for dentists. Things are getting much more competitive, especially if you’re in a big city like London and getting a job is quite difficult. You have to be on top of your skills, keep up to date with things. Try and sell yourself. In terms of what I’ve been trying to do to keep ahead of the game is networking. Knowing people in the profession who can mentor you and give you good advice and help you out and to meet lots of people to bounce ideas off is fantastic.

I think that’s the way forward in terms of building a really good community within dentistry, instead of being isolated. I think it’s quite easy to become isolated if you’re working in general practice. If you’re workig nine to five in a room with just your nurse, it can be become quite onotonous and lonely. Being able to turn to somebody for help in these hard times where patients are quite demanding and who ask a lot for you is key. Especially with managing NHS patients’ expectations, the support is really key in terms of helping you, certainly through your first few years as a young dentist but throughout your whole career, I think.

Aalok:                    Okay, cool. How many years have you been qualified now, Natalie?

Natalie:             Just over a year. I’ve finished my VT, I’m in hospital five days a week and then I work on Saturdays in practice as well.

Aalok:                           So, when you graduated, when you were first doing VT, what were you expecting? What was different or surprising in practice, would you say?

Natalie:             My practice was very nice, in terms of my patients they were very understanding. A lot of them were health professionals themselves so that helped a lot. When discussing with my friends who are in different practices, and certainly in high needs areas, what people expect from a general dentist compared to what they expect from a dentist in a hospital setting is quite different.

If you’re in hospital, a lot of the time the patients will take your word for something. They’ll respect what you say, they’ve been through the mill, they’ve had a million treatments, and at that point sometimes you’re their last port of call and ifingyou suggest a treatment and say, “This is what’s going on, this is the treatment you need to do, and this is how we’re going to do it.” Most of them will say, “Okay, that’s fine.” Whereas in practice, I’ve had a lot of situations where I’d diagnose a problem for a patient, may be a problem that they’re not even aware of, and often they say, “I don’t want that,” or, “I don’t want to pay for that,” or, “I’d rather leave it alone.” A lot of things such as tooth wear or teeth that are unrestorable but not giving patients problems, can results in patients becoming reluctant to be treated, whereas in hospital patients like to be treated and get all the treatment done.

Sometimes I think finances come into play as well. You say to a patient, “You need all these composite build-ups done on your teeth, oh and a few crowns. Because you lose tooth structure through wear, it’s going to cost you X amount.” They go, “I’m not having any problems. I’d rather just leave it. I can’t afford that,” or “I don’t want to spend the money on that.”

It was very difficult for the first few weeks getting used to asking patients for money. That’s not something you’re really taught as an undergraduate. You can do anything with your patient in hospital, it doesn’t really matter because they’re not paying for it and you’re not getting paid for it, or you’re being paid a set salary if you are working in a hospital, like I am now. In practice, you want to provide patients with treatment, but you want to still be earning a decent amount at the same time, but you are limited by what patients are willing to spend.

Aalok:                 Sure. I was at an implant course in Germany, and the implant dentist there, he sees loads of people, and he was saying that you never want to be the first person to tell someone something. You always want people to have already heard about it and know about it for a period of time. So I think you’re right. As an ethical, diligent dentist, when you’re trying to diagnose and make people aware of what’s going on, you have to do that in an informed way and not be hung up on the outcome. That is going to come over time. Knowing what you know now, what would you find useful to have been told? Were you ever shown how to present a treatment plan at university?

Natalie:             Not really. I would say that at university the treatment was  planned for you half the time. The patient had gone to see a consultant, they’d do the treatment plan, or you’d see them on a treatment plan in clinic but they would do the majority of the treatment planning for you. I think it’s more about being taught how to stage things and break things down, because a lot of the time, as you said, you focus on the end goal. You want the patient to have a beautiful smile but getting there is a lot of work and a lot of money. Communicating that to the patient, and if they actually want to start the journey, because if they drop off that journey then sometimes it can put them in a worse position than if they hadn’t even started it.

Being able to communicate costs is crucial. I have a lot of patients who complain about Band 2 treatments on the NHS, as to many people £50 is a lot. In dental school you’re not really taught how much things cost in dentistry. Like, you’ll say I’ll use a tiny bit of compule of my composite and I’ll have to throw the rest of it away. You’re wasting, like, 80% of that, but actually, how much does a compule of composite cost? How much should that translate into how much you should charge a patient for a composite? How much do your nurses get paid? How much does a practice take to run? How much does a practice take to set up, in terms of how much dental chairs cost and things like that? Just being aware of that because then you realise, actually, the value of the work that you’re giving to patients, and then you don’t feel so guilty about saying, “Well, you know, you can have three fillings for £51.” Then you think, “Actually, you know, this is good value for the patient.” I always tell my patients it’s good value.

Aalok:                I think that’s the key thing, really. In dental school, like you said, it’s all about the clinical aspect of it, which is so important, but the trouble is there’s that transition point where you need to understand a bit more about the economic reality and how to see the value in dentistry and also explain and present the value so that people can feel much better about it.  The other nice thing about working in practice is you can suddenly have access to learn about treatments and learn about being able to offer things that you couldn’t offer in dental school because it was never covered. Have there been any newer types of treatments or aesthetic dentistry developments that you’ve been more interested in since you left dental school?

Natalie:             Yes, you have a lot of patients who always ask you about tooth whitening and that is very briefly covered in dental school, but I still think that’s like bread and butter dentistry. When people come to see the dentist, a lot of the time there’s, “I’m in pain,” or, “I have this problem,” but another time it’s, “I don’t like the look of my smile,” and the fundamental thing of what people look at, generally, as well as how teeth look, is the colour of the teeth.

Tooth whitening is a relatively simple procedure but at first patients were asking me, “What does that actually do? What’s the mechanism of tooth whitening? What are the risks of tooth whitening?” and actually, I wasn’t taught that at dental school. I also get asked, “What’s the difference between different types of tooth whitening, or different products?” There are things we can use in cognition, like we did some microabrasion at university, but there’s also the new Icon treatment that I think, “Well, I have white specks on my teeth so I’m interested in that.” It’s personal preference.

We were briefly taught some orthodontics at uni, but while I know more about it now at the time, I wasn’t too aware it was another option. Now it’s, “Oh, you need orthodontics, you need to be referred to an orthodontist,” but actually, in some cases, you don’t. You can have relatively simple orthodontics done by a regular dentist. That was never really covered at university. You have a lot of patients asking for it, like everyone knows the name Invisalign, so why weren’t we taught about Invisalign at university?

Aalok:                    It makes complete sense. Also, if you’ve had the chance to, have you done any mini smile makeovers, maybe with some whitening, some bonding, some little treatments like that for your patients?

Natalie:             Yes, I have. The principles of smile design are not covered at all at university, but that’s what you need to know if you want to make someone who’s not happy with their smile, become happy with their smile. When you do cases like that, it’s very rewarding. If you do a filling, that’s not particularly rewarding. The patient doesn’t really care, they’ve just been told they need a filling. If a patient comes in saying they’re not happy with their smile, you give them treatment and they walk out happy with their smile. It’s very fulfilling when patients hug you at the end, give you a gift or say thank you and, “You’ve restored my faith in dentists.” I find that much more rewarding.

Aalok:              Absolutely. You suddenly discover this ability to emotionally impact somebody and you may not have had that experience at dental school. Have some of those experiences shaped your interest in different subjects and things that you want to learn more about, would you say?

Natalie:             Yes, definitely. I’ve become very interested in composites. Simple composites aren’t that difficult if you learn and know how to use the equipment, get the right equipment and learn the basics of how to do simple bonding. Like adding tiny bits of composite to improve someone’s smile is a very simple treatment, but very rewarding. I’m quite interested in things like that. I find it very therapeutic, building up teeth with composite if I have enough time. Everything’s isolated really nicely, the patient’s dozing off, and you’re there with a paintbrush and a flat plastic. Then you show them in the mirror, and a lot of the time they’ll say,, “Wow, I didn’t realise you could do that!” It’s very simple to do.

Aalok:               That’s absolutely fantastic. What made you choose to go for a hospital position afterwards? What was your motivation for that?

Natalie:             I wanted to go back into a learning environment. I thought there were lots of opportunities in hospital, working under consultants who’ve been practicing for twenty, thirty years. There’s a lot they can teach you. Things that you didn’t even think about seem really obvious as soon as they say it, or a particular technique. Seeing more complicated patients that I wouldn’t feel comfortable treating in practice, but being able to treat them under supervision in hospital.

I was quite picky with my hospital post as well. I really wanted to do a post that either involved general duties or a similar level of restorative practice because I thought doing restorative is what you do generally and I don’t really see myself specialising yet. I think if I was to do, for example, a max fax post, there’s a possibility of being deskilled in what general practitioners do every day; drilling and filling. So having a post that I really want to do in restorative keeps my skills up but also enhances them by working with really skilled specialists, and managing cases like tooth wear and things like that.

Aalok:                   Fantastic. What are your goals for the future? What areas do you think you want to learn more about and gain more experience in?

Natalie:             I think it’s important not to get ahead of myself. There are lots of things you can do. You can do botox, facial aesthetics, everything. I think as a general practitioner, it’s important to really know your basic skills first. So one of my priorities is to do an endo course because that’s the sort of thing that at the moment I don’t really enjoy endo that much but I think it’s because it’s something I’m not that confident in. So it would be beneficial to enhance the skills I can give to patients. I think some more composite courses would be really good.

Eventually, some short-term orthodontic courses. I’ve already been on one but I would rather go on several, because there are so many different systems out there which all offer different support and can contradict recommendations. I know a lot of them are quite similar, but I think as with anything, shop around, get confident, find one that you’re comfortable with, and then eventually start offering patients treatment like that.

Aalok:                         I definitely think it’s important to get opposing viewpoints because in life there is no one way, and in dentistry there is no one way. There are many ways of doing it, and it’s important to be able to understand as many of those modalities in treatments, so that you can offer a balanced viewpoint, because ultimately your patients are asking you for your recommendation. So it’s important that you’re able to do it. One of the things that’s really interesting about you, Natalie, is that you’re very proactive, and even, entrepreneurially minded. What made you start your blog? What was your thought process behind that?

Natalie:             I actually really wanted to start my blog a long time ago when I was at dental school, but social life and then finals got in the way. I’m really into education and I think at some point I need to do some sort of teaching post, whether that be at hospital or becoming a foundation trainer. I really enjoy education. At the moment, whenever there’s an opportunity where someone says, “Do you want to supervise the undergrad?” I’ll say, “Yes, I’ll do it.” I really want to spread my enthusiasm of dentistry. Everyone’s very negative at the moment. Everyone’s getting sued, DGBC are rubbish, patients are over demanding, they want everything for no money. It’s not a very nice environment sometimes when you hear all this negativity. You hear it at dental school, you hear it in your first few weeks of foundation training, you hear it in hospital, and it can become quite depressing, really.

I think it’s important to try and keep everyone’s morale up, because actually dentistry is a really rewarding career. It can be very sociable, and in hospital it’s very social, and everyone’s out to support each other. When you’re in a big city like London, there are always dentists meeting up all the time and there are always social events going on. It’s important to keep everyone else positive.

Aalok:                   What tips would you give for people in VT or at a similar stage to yourself to be more entrepreneurial and more proactive, so that they can shape their future as they want to?

Natalie:             Grab any opportunity that comes your way. It’s easy just to finish a job at five o’ clock, go home, watch Netflix and go to bed, but it’s good to keep going after work in terms of it doesn’t have to be the same thing all the time. There are so many different types of dentist out there. Different events to go to. Think of something that you’d enjoy, that you enjoy in your day or try and find your niche, whether that be tooth whitening or providing composites or really being an advocator for good oral hygiene and perio.

If you want to do something, do it. There’s lots of support out there. Find someone who can mentor you through that. Getting in contact with as many dentists as you can in your area and beyond, and just don’t feel intimidated. You’re a young dentist, yes, but that doesn’t mean that you don’t know anything. No one’s going to shoot you down for saying something wrong or being naive. You’re not naive, it’s just learning as much as you can. 

In life as a dentist, you’re never going to stop learning. If you graduate after five years at dental school and think that’s it, then that’s not what a good dentist should be. A dentist who wants to give the best to their patients knows that they’ll be learning throughout their career, whether they’re two years graduated, twenty years graduated, fifty years graduated.

Aalok:             Perfect.. Thank you very much for your time, Natalie.

It’s insightful for everyone to know. I think it’s hard that you seem to be getting hit with a lot of negativity straightaway when you graduate at the moment, but there’s still so much opportunity there. I commend you, and good for you in the fact that you’re proactively seeking and learning and pushing and going forwards. You’ve got the right attitude and the more people that see what you’re doing, the more they can feel confident that they could do something too. It’s brilliant that you’re helping and sharing.

Natalie:             Thanks. That’s what my aim is. I’m glad.

To learn more from Natalie about the opportunities and obstacles facing young dentists today, visit her blog; A Tooth Germ HERE.

Are you a new or experienced dentist? If you have thoughts on this subject please join our community and comment on this post by sharing your advice below.

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